Designing a System for Patients Controlling Providers’ Access to their Electronic Health Records: Organizational and Technical Challenges

BACKGROUND Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients’ rights to control their personal information with providers’ data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients’ preferences for patient-controlled EHR access and applying those preferences to an existing EHR. METHODS We established an online system for capturing patients’ preferences for who could view their EHRs (listing all participating clinic providers individually and categorically—physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients’ preferences to guide data displays to providers. RESULTS Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a “Break the Glass” button to override patients’ restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. CONCLUSIONS Assessing patients’ preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

Golden Opportunity or False Hope? Anglogold Ashanti's Proposed Gold Mine in the Democratic Republic of Congo

Deals with the exploitation of resourcesin DR

Video in development : filming for rural change

This book is about using video in rural interventions for social change. It gives a glimpse into the many creative ways in which video can be used in rural development activities. Capitalising on experience in this field, the books aims to encourage development professionals to explore the potential of video in development, making it a more coherent, better understood and properly used development tool - in short, filming for rural change

Experiences of drug adherence by HIV infected adolescents in Bulawayo, Zimbabwe

This study articulates the lived experiences regarding drug adherence by adolescents in Zimbabwe. The study was conducted in Bulawayo, the second largest city in Zimbabwe to aid understanding the experiences the adolescents go through as they try to live as normal a life as possible despite them having the most stigmatised condition in the country in particular and the world at large. A phenomenological inquiry was undertaken using Wertz’s (1983, 2005, 2011) empirical psychological reflection approach for data analysis, after utilizing purposive, convenience and criterion sampling techniques to select thirteen (13) adolescents who were on ART and were in good health and also willing to take part in the study. Data were generated using in-depth qualitative interviews and the interviews continued until data redundancy was reached. The interview proceedings were digitally audio-recorded in addition to taking field notes and these were transcribed verbatim. Data analysis occurred at idiographic and nomothetic levels according to the principles of Wertz’s empirical psychological reflection. Thematic analysis of the research data revealed six (6) themes namely: Treatment fatigue. Delay in getting to know own HIV status. Stigma Disability (visual impairment). Lack of support. Religious beliefs (church). Wholeness emerged as the single most encompassing and accommodating concept that united the various themes and categories. It further grounded adolescents’ experiences regarding drug adherence and coping with challenges associated with HIV. The findings add substantial knowledge about how adolescents experience drug adherence. Important recommendations are made and guidelines that may be used to increase adolescents’ resilience to challenges of being HIV infected are suggested.Health StudiesD. Litt. et Phil. (Nursing

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

OBJECTIVE: To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING: Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. STUDY DESIGN: We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests—a machine learning algorithm—using the remaining 20% of cases. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from two sources: VHA's Corporate Data Warehouse and National Homeless Registry. PRINCIPAL FINDINGS: Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model‐predicted risk. CONCLUSIONS: Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the HSCR screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Grant/Award Number: IIR 13-334 (IIR 13-334 - U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSRD))Accepted manuscrip

Health care for asylum seekers on Nauru and Manus Island

This paper sets out the key clauses of the government contract for health care provision to asylum seekers on Nauru and Manus Island, and examines their adequacy in providing for mental and physical health needs.IntroductionWith the recent return to processing of asylum seekers in Regional Processing Centres (RPCs) on Nauru and Manus Island, a major concern for refugee advocates and human rights groups is the mental health status of asylum seekers being accommodated in these facilities. This concern stems from the perceived lack of specialist mental health resources available and the indefinite nature of detention. Previous experience has shown that offshore processing of asylum seekers can have serious consequences for both physical and mental health.Amnesty International raised concerns about the physical health of asylum seekers in its November 2012 review of the Nauru Offshore Processing Facility, as conditions in the processing centres, such as heat, lack of shade and inadequate accommodation, were considered to be contributing to poor physical health. More recently, the ABC program Four Corners highlighted the conditions in the Nauru and Manus Island processing centres, and the concerns of former staff about access to health care and the health status of asylum seekers in this context.As at 27 May 2013, there were 430 asylum seekers on Nauru and 302 on Manus Island. The combined total capacity of the facilities on Nauru and Manus Island is expected to reach around 2,100 by the end of 2013 (600 on Manus Island and 1,500 on Nauru). Current capacity is 500 on Manus Island and 528 on Nauru.The provision of health care to asylum seekers on Nauru and Manus Island is governed by the ‘Heads of Agreement’ between the Commonwealth of Australia (represented by the Department of Immigration and Citizenship (DIAC)) and International Health and Medical Services (IHMS) (the contract). The contract was tabled in the Senate on 21 September 2012, with the payment schedule and financial details redacted. Despite this, some financial details are known, such as that IHMS will be paid $22 million for the provision of health care for six months from 14 December 2012. The contract was not published online and is only available from the Senate Table Office. In the absence of an online document, this background note will set out the key clauses of the contract and examine their adequacy in providing for the mental and physical health needs of asylum seekers being detained in RPCs.IHMS has provided health care services in immigration detention facilities in Australia since 2006. As at March 2012, the value of the two contracts with IHMS (one for a six year period covering services for Christmas Island and one for a five year period covering the mainland) was estimated to be$769.3 million. In 2010–11 more than 100,000 individual health services were delivered in immigration detention facilities. The number of IHMS community-based health service providers increased by 40 per cent to more than 700 in 2010‑11. These providers deliver services to the community detention network on behalf of IHMS. There is no provision in the contract to penalise the organisation for underperformance.In May 2013, the Government announced that families who arrive by boat would be considered for bridging visas in the community, but would be subject to the same ‘no advantage’ principle as those held on Nauru and Manus Island. It is likely that these asylum seekers will not have the same access to health care services as those on Nauru and Manus Island, as they will not have access to Medicare and it does not appear that DIAC has a specific contract for the provision of health care services to this group in Australia. Exploration of this issue is outside the scope of this paper

Hemispheric lateralisation and immune function: A systematic review of human research

This is the post-print version of the final paper published in Journal of Neuroimmunology. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2011 Elsevier B.V.Past studies examined relationships between hemispheric lateralisation (HL) and immune system functioning. However, there has been no up-dated systematic review of this research area. This article reviews relevant published studies, evaluates study quality and effect sizes. Eleven studies were selected: three revealing a relationship between weaker left hemisphere function and poorer immune function, three describing a relationship between weaker right hemisphere function and stronger immune functioning, and five describing both relationships. Mean effect-size of the studies was r = 0.536 (range 0.280–0.866). Collectively, studies point at left-HL and stronger immunity relationships. Limitations, mechanisms and clinical implications are discussed